MARYLAND DEPARTMENT OF TRANSPORTATION - DOC

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					MARYLAND DEPARTMENT OF TRANSPORTATION                                                                     Division of Documents & Permits
MARYLAND AVIATION ADMINISTRATION
                                                                                                                 P.O. Box 8766, BWI Airport

APPLICATION FOR SINGLE TRADE PERMIT                                                                                     Maryland 21240-0766
     Electrical               Gas                                                                                          Tel. 410-859-7796
     Mechanical               Fire Safety                                                                                  Fax: 410-859-5440
     Plumbing                 (Fire Sprinkler, Fire Alarm, Suppression)
One application per trade only. If additional trades are added to the scope, within a period of 180 days from the date of last
approval, the applicant will be required to submit a Building Permit application for the entire project.

GENERAL INFORMATION (To be completed by the applicant, please print)
Project Name:                                                                               Airport:                    BWI
                                                                                                                        MTN
Project Location:                                                                           Tenant Space No.

Name of Applicant/Tenant                                                                    Tel.:
                                                                                            E-mail:
Contact Person:                                                                             Tel.:
Representing:                                                                               E-mail:
Mailing Address:                                                                            Emergency Contact and Number:


Brief Description of Project:                                                               Check Appropriate Box:
                                                                                            Existing Tenant?
                                                                                            New Tenant?

Estimated Construction Cost (Required):                $
Name of Master Electrician, Master Plumber or Master HVACR:                                 Tel.:
                                                                                            E-mail:
MD License No.:                                  Expiration:                                Cell/Emergency No.
Company/Organization:                                                                                Work By MAA Employees
Street Address:                                                                             Funding Source:
City, State, Zip:                                                                           Supervisor’s Name:
Maryland Business License Number
*Attach Photocopies of Current MD License and Insurance Certificate
                                                                                            Supervisor’s Signature:
Check Appropriate Box:
                                                 Yes     No                                                              Yes     No
Will a crane be required during construction?                         Will the work be done in a “Confined Space?”
Will the work involve “Hot Work/Welding?”                             Will the work require trenching and excavation?
Will the work involve High Voltage?

If the answer to any of those questions is Yes, additional permits are required.
Applicant’s Signature:                                                                                  Date:


                                                       FOR OFFICE USE ONLY
                                                 Yes      No                                                                   Yes    No
Is the Application Form complete?                                        Is Safety Plan provided?
Is Insurance Certificate provided?                                       Are Drawings sufficiently complete?
Is Copy of Trade License provided?                                       Are additional permits required?

Permit Coordinator                                                                                     Date:
                                                                                                       STP Number:
Date Received:

Date of Meeting:

Date of Release:



                                                                                                                           MAA-178 R-1/12

				
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posted:10/3/2012
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